Osgood-Schlatter Disease

Patient information for parents and carers — Dr Christopher Spelman, Orthopaedic Surgeon

What is Osgood-Schlatter disease

Osgood-Schlatter disease is one of the most common causes of knee pain in active, growing children and adolescents. It is a “traction apophysitis” – irritation of the growth area (apophysis) at the top of the shin bone, called the tibial tubercle, where the patellar tendon from the kneecap attaches. During the growth spurt this area is still made partly of cartilage and has not yet fused to the rest of the bone, so the repeated, powerful pull of the quadriceps and patellar tendon during running and jumping irritates it, causing pain, swelling and a tender bump just below the kneecap.

It is important for families to understand that this is not an injury or a disease in the usual sense, and it does not damage the knee joint itself. It is a self-limiting condition of the growing skeleton that settles once growth is complete.

Who gets it

Osgood-Schlatter disease typically affects children between about 10 and 15 years of age, coinciding with the adolescent growth spurt (usually a little earlier in girls than boys). It is most common in those who play running and jumping sports such as football, basketball, netball, athletics and soccer. It affects both knees in a significant proportion of children, though often one side is worse. Tight or weak thigh muscles and a rapid growth spurt increase the likelihood.

Symptoms

The typical features are:

●      Pain and a tender, sometimes prominent bony bump just below the kneecap, over the tibial tubercle

●      Pain that is brought on by activity – running, jumping, kneeling, squatting and going up or down stairs – and eases with rest

●      Discomfort when kneeling directly on the bump

●      Symptoms that flare with increased training and settle with relative rest

The pain is activity-related. Pain that is present at rest or at night, or that is not clearly linked to activity, is not typical and should prompt review to exclude other causes.

Diagnosis

Osgood-Schlatter disease is a clinical diagnosis, made from the history and examination – the characteristic location of the pain and the tender bump are usually enough. Imaging is not required to make the diagnosis. X-rays are used only where the picture is atypical (for example, rest or night pain, a history suggesting a different problem, or a suspected acute avulsion fracture of the tubercle), and may show fragmentation of the tubercle or, in longer-standing cases, a separate piece of bone (an ossicle) within the tendon.

Treatment

Treatment is about controlling symptoms while the child grows, and – importantly – it usually does not require giving up sport altogether. The aim is to keep the child active within the limits of their pain. Helpful measures include:

Activity and load management

Rather than complete rest, the training load is adjusted so that the child stays below the level that provokes significant pain, with relative rest during flare-ups. A short reduction in the volume of running and jumping usually settles a flare, after which activity is gradually built back up. A simple guide is that a mild ache that settles quickly is acceptable, whereas pain that limits performance or lasts into the next day means the load is too high.

Physiotherapy

A programme to stretch and strengthen the quadriceps, hamstrings and calf, and to address any tightness or weakness, is the mainstay and helps both symptoms and return to sport.

Simple symptom relief

Ice after activity, simple pain relief such as paracetamol or a short course of anti-inflammatory medication for flare-ups, and an infrapatellar strap or padding over the bump for kneeling comfort can all help.

Outlook and prognosis

The outlook is excellent. Osgood-Schlatter disease resolves as the growth plate at the tibial tubercle closes at the end of growth, and it does not cause long-term harm to the knee. Many children are left with a permanent, painless bony bump below the knee, which is of no consequence other than appearance and occasional discomfort when kneeling on it. Symptoms can persist for months and fluctuate with activity and growth, so patience and reassurance are key.

When surgery is (rarely) considered

Surgery is not part of the treatment of Osgood-Schlatter disease in a growing child. In a small proportion of patients – roughly 5–10% – disabling pain persists after skeletal maturity, usually because a separate piece of bone (an ossicle) has formed within the patellar tendon and remains painful in adulthood. In these selected cases, once growth is complete, removing the ossicle (with tidying of the tubercle) can relieve symptoms, and reported series show most such patients return to sport, typically within a few weeks to a few months.

Complications

Osgood-Schlatter disease is benign, and complications are uncommon:

●      Persistent symptoms into adulthood from an unresolved ossicle, in a minority of patients

●      A permanent painless bony prominence below the knee (cosmetic, and occasionally uncomfortable when kneeling)

●      Rarely, an acute avulsion fracture of the tibial tubercle during a vigorous jumping activity, which is a separate, acute injury that may need treatment in its own right

●      Where surgery is performed in adulthood, the usual low risks of a minor knee procedure (infection, stiffness) apply

Summary

Osgood-Schlatter disease is a common, self-limiting cause of knee pain in growing, active children, caused by irritation of the growth area where the patellar tendon attaches to the shin. It is managed with load management, physiotherapy and simple symptom relief, rarely requires stopping sport completely, and resolves with growth. Surgery is reserved for the small number who have ongoing pain from an ossicle after they have finished growing. Dr Spelman can confirm the diagnosis, provide reassurance and guide a return-to-sport plan.